According to a recent audit by the Office of Inspector General of the U.S. Department of Health and Human Services, 22 of the 23 Consumer Operated and Oriented Plans (Co-ops) created under the Affordable Care Act lost money in 2014. Furthermore, most of the co-ops have enrolled fewer people than they had predicted and have continued to perform poorly in 2015.

Co-ops are nonprofit health insurers that were formed to compete with larger insurers in offering health plans through the state exchanges, or "marketplaces," as well as on the website. Participants in the co-op program received $2.4 billion in startup loans from the Centers for Medicare & Medicaid Services (CMS). Unprofitable co-ops will likely have difficulty repaying these federal loans, and CMS recently increased financial reporting requirements in order to better monitor co-ops’ performance.

Co-ops were previously discussed here